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Running head: REFLECTION OF KOLCABA'S THEORY 1

Reflection of Kolcaba's Theory of Comfort


Melissa Bisel
Ferris State University




REFLECTION OF KOLCABA'S THEORY 2
Abstract
The purpose of this paper is to reflect on how Kolcabas Theory of Comfort can be used to create
an interdisciplinary care approach for end-of-life and palliative care. It is important as nurses to
understand the importance of providing quality care for the patient and the family throughout the
end of life process. As a result of this assignment, I found that Kolkabas theory is a good theory
to use during the end of life process. The specific strategies described, which include physical,
psychospiritual, sociocultural, and environmental, helps determine what the patients and families
need in terms of end of life care. After determining what the patient needs, the nurse can develop
a plan to provide quality care beyond expectations. I have learned from this assignment the
importance of viewing the patient and family as a whole and being culturally competent. During
this time, nurses need to put their views aside and do what is best for the patient.
REFLECTION OF KOLCABA'S THEORY 3
Reflection of Kolcabas Theory of Comfort
The purpose of this assignment is to reflect on how Kolcabas Theory of Comfort can be used to
generate a care approach for end-of-life and palliative care. Throughout this reflection, I will
describe strategies that empower patients and families particularly related to Kolcabas theory.
Next, there will be a reflection on skills needed to engage patients at the end of life. This paper
will then discuss planning, implementation, and evaluation care specifically related to end of life.
Finally, there will be a reflection of Kolcabas Theory using the LEARN approach.
Knowledge
The Theory of comfort describes specific strategies to empower patients and families at
the end-of- life. Kolcaba and DiMarco (2005), defines comfort as "the immediate state of being
strengthened through having the human needs for relief, ease, and transcendence addressed in
four contexts of experience (physical, psychospiritual, sociocultural, and environmental)"
(p. 187). A taxonomic model was created to use a more holistic approach to ensure that the needs
of patients and families were being met by first identifying the need, then designing interventions
to meet the need, and lastly determining if the interventions were effective.
Kolcabas Comfort Theory looks at three behaviors in which human needs are addressed,
which include relief, ease, and transcendence. According to Kolcaba (2005), relief is the state of
having your pain mitigated or alleviated (p.187). Ease is the absence of specific discomfort,
and transcendence is the ability to rise above discomforts when they cannot be avoided (p.
187). The three behaviors are part of a holistic model that guides care for patients and families at
the end of life.
When looking at the theory of comfort, Kolcaba then uses those behaviors in combination
with four general contexts, which include physical, environmental, sociocultural, and
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psychospiritual. The physical context applies to bodily sensations and homeostasis, for example,
pain. The psychospiriutal context refers to the awareness of self, esteem, sexuality, and the
meaning of life. Environmental looks at the external background of human experience. Light,
noise, and temperature have a huge impact on how a person feels. The last context, sociocultural,
looks at the interpersonal, family and societal relationships, family traditions, and rituals. Each of
these contexts is an important part in the comfort of patients and families when dealing with
death and the dying process.
Skills
By understanding the knowledge behind Kolcabas Theory, I will now discuss the skills
needed to engage patients and their families to promote health, safety, and transcendence
throughout the end of life. The three skills that Kolcaba highlights include: comforting, coaching,
and providing technical care. Each of these care methods is crucial in order to provide the best
care for the patient and their family.
The first technique for empowering the patient and their family during end of life is
technical care, which includes repositioning, monitoring symptoms, and preventing
complications. An example of using this skill would be giving the patient Zofran when nauseous.
Giving the patients medications for their symptoms in a timely matter makes them feel better and
shows the patients and the families that you care about them. When patients are dying, they can
sometimes feel short of breath, which is very uncomfortable. Giving the patient oxygen will
decrease the discomfort of the patient but also make it easier for the family. Technical skills are
very important in the dying process, it makes a huge difference in the way the patient dies and
also how the family perceives their death.
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Coaching is another technique discussed by Kolcaba. This skill discusses the importance
of listening, providing reassurance, encouraging, and creating a plan for optimizing health
(Kolcaba 2007). According to Puchalski (2002), It is our responsibility to listen to people as
they struggle with their dying. We need to be willing to listen to their anxieties, their fears, their
unresolved conflicts, their hopes, and their despairs (p. 290). Communication skills are
important for quality end-of-life care. While learning general communication skills, such as
therapeutic listening, has been common in nursing education, learning specific communication
tools, is imperative at the end of life stage. In a study conducted by Shannon, Long-Suttehul, and
Coombs (2011), the tools that were most effective in assisting nursing: Ask-Tell-Ask and Tell
Me (p.124). To explain this a little better, the Ask-Tell-Ask phrase reminds nurses to carefully
assess concerns before imparting information. The Tell Me provides a tool for encouraging
dialogue in challenging situations. Using therapeutic communication skills along with asking
questions and encouraging dialogue will encourage patients and families to engage in the care
being provided, which is essential.
Comforting is the last technique that I will discuss. This technique can be used with
patients and their families to empower them by promoting health, safety, and exceeding their
expectations when dealing with an end of life event. For patients and families coping with end of
life, spirituality has a big impact. According to Puchalski (2002), Spirituality helps people find
hope in the midst of despair (p. 290). Spirituality may be one way to provide comfort, some
other ways include: making the patient feel cared for, the environment, message, encouragement,
and the connection with the patient and family.


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Attitudes
To provide quality care at the end of life nurses must have a good attitude about palliative care. It
is important as a nurse to view things through the patients eyes and respect and encourage
individual expression of patient values, preferences, and expressed needs. It is not the nurses
position to judge or create conflict. According to Cronenwett et.al (2007), the QSEN competency
of patient centered care recommends that nurses seek learning opportunities to educate
themselves about the end of life process and to accommodate individuals based on their views.
Part of the nursing attitude is to recognize that patient expectations influence outcomes in
management of pain or suffering. It is the goal of the nurse when providing patient cantered care
to disregard their own views if needed to meet the needs of patient and family (p. 123).
Reflection
Looking back and reflecting on this assignment, I realize that I did not know very much
about end of life care. I have not had much experience with dying and how to handle it, but after
researching the Kolcaba theory, I now feel like I have the skills and knowledge that I can
incorporate into my nursing practice. As I was completing this assignment, I thought a lot about
how I would want my family members to be treated going through the end of life process. I feel
like this assignment has helped me acknowledge that the care is not only provided to the patient
but is equally important to provide care for the family. This was a challenging assignment for me
because there are so many aspects of end of life care and I wanted to include everything. Each
person is very different, so the care nurses provide needs to be tailored to each individual and
family.
After researching the Kolcaba theory, along with other nursing journals, I feel confident
in providing care to end of life patients and their families by treating the individual in a holistic
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manner and using the skills I discussed above to provide quality care. I feel that every situation is
going to be different, and I have to use the skills that I have learned to provide patient centered
care. Kolcabas theory was very useful in teaching me the knowledge and skills to provide end of
life care, I think I just need more hands on experience. The advantage of using Kolcabas theory
to communicate patients needs is useful because it takes a holistic approach and touches on
every need. I liked how she looked at the physical, psychospiritual, environmental, and
sociocultural aspects of care. That gives a more rounded approach when caring for end of life
patients. When communicating to an interdisciplinary team, there is an advantage of using a
theory because other people of the interdisciplinary team can understand the concepts that
provide quality care to patients and families. When nurses apply Comfort Theory, they
competently consider in a compassionate way, the uniqueness and complexity of each whole
patient within the context of the family system. Thus, the theory offers a proficient way to guide
care and communicate to the interdisciplinary team the interventions that work.
By having nursing knowledge, you can educate others about the importance of using
holistic care at the end of life. I think that if nurses are more compassionate about patient care
and the attitude of the nurse will carry over to others. Kolcabas theory includes a wide spectrum
of ways to comfort patients and families. Revision of care depends on the individual and what is
important to them. When dealing with the end of life process, in the future, I will use Kolcabas
theory to empower patients and families.
Conclusion
By implementing Kolcabas theory, a nurse can effectively provide patient centered care
to end of life patients and their families. Using a holistic approach is very important because
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everyones needs are different. By assessing needs, implementing a plan, and evaluating the
outcomes a nurse can provide quality care that will have a huge impact on the patient and family.





















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References
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P.(2007). Quality
And Safety Education For Nurses. Nursing Outlook, 55(3), 122-131.
Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric nursing.
Pediatric Nursing, 31(3), 187-194.
Puchalski, C. (2007). Spirituality and the care of patients at the end-of-life: an essential
component of care. OMEGA: The Journal of Death and Dying, 56(1), 33-46.
Shannon, S. E., Long-Sutehall, T., & Coombs, M. (2011). Conversations in end-of-life care:
communication tools for critical care practitioners. Nursing in Critical Care, 16(3), 124-
130.